Today, some 18.5 million U.S. adults are estimated to be addicted to a substance. Data shows that some 3% of U.S. adult women struggle with a drug use disorder and a further 10.4% have an alcohol use disorder. While women make up narrower proportions of the population with substance abuse problems, millions of women struggle with substance abuse and addiction. Yet, addiction is still seen as a men’s problem, with healthcare, rehab, and facilities largely catering towards male needs.
Women, who face different social backgrounds, different biology (and therefore different biological responses to substances), different learned behaviors, and different hormones respond to substance abuse and to recovery differently than men. Therefore, it is crucial to recovery to recognize and account for those differences in order to support and ensure a full recovery.
1) Women Cope Differently than Men
Women often take substances to cope with stress, especially relationship, family, and job stress. While men do the same, women do so in private, out of sight, and with substances available at home. As a result, women are significantly like to abuse and depend on prescription painkillers and alcohol. Where men quite often become addicted to substances as part of social routines and performative usage, women use in secret and those around them may not be aware that anything is wrong. This can be seen, even in physical health, where women choking are more likely to run to a bathroom where they are unable to get help, where men are more likely to remain seated.
This is crucial for women in recovery, because real recovery means shifting coping mechanisms away from private and towards public and social roles. Coping with cravings means seeking out people to talk to, public help, and therapy, and that can mean dramatic shifts in the ego, self-presentation, and self-acceptance.
2) Women Abuse Substances Differently than Men
In the Caron Study, women were shown to most frequently abuse substances alone, in the privacy of their own home. This largely links to the fact that women with substance abuse problems are more likely to be using to cope with stress relating to family, motherhood, relationships, and an inability to get out of relationships.
Female biology is also an important factor in both recovery and addiction. Women tend to metabolize substances more quickly than men, leading to faster rates of addiction when taking smaller amounts of substances. While this is especially noted with nicotine, it remains true across opioids and with alcohol. So, while women are more prone to abusing smaller amounts of substances at home and in private, they are also highly likely to become addicted based on those small amounts of a substance.
3) Women are More Vulnerable to Domestic Abuse
Depending on age group, 55-95% of all women in rehabilitation have experienced trauma, including domestic abuse, violence by a partner, rape, and traumatic relationships at home. While men also struggle with domestic abuse and violence, women are significantly more vulnerable and may use substances as a coping mechanism. Domestic abuse and rape lead to trauma, PTSD, and other mental health problems co-occurring with addiction. Some studies show that 7 out of 10 women in rehabilitation have experienced sexual assault or rape. SAHMSA also shows that 33-55% of all women experiencing gendered violence eventually experience PTSD, which creates additional health problems, creates huge risks for relapse, and directly interferes with treatment. This is also important in treatment centers, where women experience gendered violence from peers and from facilitators, leading many to suggest that women can only safely seek treatment in gendered groups.
At the same time, women, especially women with families, are often reliant or codependent on their abusers. A woman seeking out addiction treatment who returns to the same situation, especially in a stressful or violent household, is significantly likely to relapse. This can be mitigated with family therapy, parenting classes, and relationship therapy, but may also require mitigation through shelters, job-placement, and childcare services to help her establish herself outside of an abusive partners control.
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4) Pregnancy Can Complicate Recovery
Pregnancy significantly complicates addiction and recovery, with hormones, emotional spirals, and increases in depression and negative moods. Pregnancy also increases reliance on a potential caregiver, who is likely also using and may be violent. Because women abusing substances are significantly more vulnerable to risk-taking behavior, unprotected sex, and sexual assault and rape, they are significantly more likely to experience an unplanned pregnancy. Moving into recovery, this pregnancy can cause significant stress, emotional distress, and financial distress, which may impede recovery and may result in a relapse.
Providing adequate childcare and family therapy during treatment is critical, but women moving into recovery also need adequate solutions for contraception and family planning.
5) Most Addiction Research is About Men
While men make up a larger portion of addicts than women, just 8% of addiction research is focused on women. This is hugely problematic for women, who metabolize substances differently, are raised differently, and face different social and economic backgrounds than most men. While there is considerable overlap in why and how men and women abuse substances, women are biologically different, raised with different behaviors, and face different social and economic stressors and demands. Tailoring treatment to meet the needs and problems of women greatly improves outcomes.
6) Women are Heavily Influenced by Substance Abuse
Women are often raised to considerably different social standards than men. Many are taught to be “gatekeepers”, “pure” and to take care of others. The result can be considerable when women turn to substance abuse, and considerably different than the male reaction. This is especially evident in the ego. Where men turn outwards and use their sense of self to deflect criticism and blame, women turn inwards, often losing their sense of self to substance abuse. Long-term recovery must focus on rebuilding the ego and the sense of self into a healthy and balanced structure. Without that, women might feel lost, depressed, and struggle to find motivation or reasons to remain clean or sober outside of externally motivating factors such as a partner or children.
7) Women are More Vulnerable to Relapse Triggers
While not all women face economic, financial, social, and familial stress, women are significantly more likely to experience these than men. Moving out of treatment, women are significantly more likely to be paid less, to struggle with finding a job, to be the sole caretaker of a child, to experience domestic violence, and to experience sexual assault. These factors can create immense stress and can greatly contribute to relapse.
8) Women Experience Greater Levels of Stigma and Ostracization for Substance Abuse
Women avoid seeking out treatment, continuing treatment, and attending support groups, largely because of associated stigma around substance abuse. This stigma is largely heavier for women than for men, with women facing more societal pressure to be or to remain “pure”.
Substance abuse stigma is so strong that many people believe women have a harder time becoming addicted. Doctors share this stigma, often failing to realize a patient is abusing a substance until it is much too late. The result has been a significant rise in women overdosing on prescription medication, often because they aren’t handed the same strict risk evaluation and management as men given the same medication.
9) Women are More Prone to Mental Health Problems
Co-occurring mental health problems and mental illnesses are significant contributors to relapse, and women are more vulnerable and more prone to many mental illnesses. The World Health Organization shows that women are almost twice as likely to have anxiety and depression as men. Without treating those disorders, women with co-occurring mental health problems will likely eventually relapse.
10) Childcare and Support is Often a Barrier to Treatment
Women are more likely to be sole caretakers of children and to have child caretaking duties. Many women avoid seeking out treatment because that might involve leaving family members, investing in expensive daycare, or entrusting family members to another parent who might also be addicted. In 2008, just 8% of rehabilitation facilities in the United States offered childcare. While that is changing, rehabilitation facilities have to offer significant and visible childcare and child involvement programs to include single mothers in treatment and recovery.
Women experience addiction and recovery differently than men. Being aware of those differences can help you to seek out female-focused addiction treatment, to follow up with appropriate aftercare, and to take steps to prevent relapse following treatment. Today, many rehabilitation facilities are updating programs to include women-only groups, to incorporate childcare and family therapy, and to provide long-term aftercare with sober living homes, job placement, and follow-up therapy to prevent relapse.